Tzu-An Chen

Impact of an Active Video Game on Healthy Children’s Physical Activity

OBJECTIVE: This naturalistic study tests whether children receiving a new (to them) active video game spontaneously engage in more physical activity than those receiving an inactive video game, and whether the effect would be greater among children in unsafe neighborhoods, who might not be allowed to play outside. METHODS: Participants were children 9 to 12 years of age, with a BMI >50th percentile, but <99th percentile; none of these children a medical condition that would preclude physical activity or playing video games. A randomized clinical trial assigned children to receiving 2 active or 2 inactive video games, the peripherals necessary to run the games, and a Wii console. Physical activity was monitored by using accelerometers for 5 weeks over the course of a 13-week experiment. Neighborhood safety was assessed with a 12 item validated questionnaire. RESULTS: There was no evidence that children receiving the active video games were more active in general, or at anytime, than children receiving the inactive video games. The outcomes were not moderated by parent perceived neighborhood safety, child BMI z score, or other demographic characteristics. CONCLUSIONS: These results provide no reason to believe that simply acquiring an active video game under naturalistic circumstances provides a public health benefit to children.

School Year Versus Summer Differences in Child Weight Gain: A Narrative Review

The causes of the current high prevalence of overweight and obesity among children are not clearly known. Schools have been implicated in the causal chain to high child obesity prevalence. Recent studies have compared school year versus summertime changes (herein called seasonal differences) in child adiposity or related phenomena. The most common seasonal pattern in six longitudinal descriptive studies was that overweight and obese children experienced accelerated gain in weight or some BMI indicator during the summer, whereas healthy weight children gained less or not at all. Four physical activity (PA) intervention studies demonstrated that school year fitness improvements were lost during the summer. One study showed that PA declined across the summer. Another study provided conflicting results of lower total energy expenditure in the summer, but no seasonal difference in total energy expenditure after adjusting for fat-free mass. This pattern of fairly rapid seasonal differences suggests that PA is the primary factor contributing to seasonal differences in weight or BMI, but the documented seasonal pattern in PA (i.e., higher in summer) does not support this relationship. Sleep duration has also been inversely related to child adiposity. Seasonal patterns in adiposity, PA, and sleep need to be clearly established separately for overweight and healthy weight children in further longitudinal research to provide a clear focus for national policy.

Evaluation of a web-based program promoting healthy eating and physical activity for adolescents: Teen Choice: Food and Fitness

This randomized clinical trial tested the impact of a website promoting nutrition and physical activity for adolescents (Teen Choice: Food and Fitness). Participants, (408) 12- to 17-year-old adolescents in the Houston area, completed online surveys measuring diet, physical activity, sedentary behavior and diet/physical activity mediators at baseline. After randomization, they were asked to log onto either the intervention or the control condition website weekly for 8 weeks to review web content and set goals to improve dietary and physical activity behaviors. Post-test occurred after 8 weeks. Logistic regression analyses and one-way analyses of covariance were used in the analyses. At post, more intervention group adolescents reported eating three or more daily vegetable servings in the past week compared with the control group (P < 0.05); both groups reported significant increases in physical activity (P < 0.001) and significant decreases in TV watching (P < 0.01). Average log on rate was 75% over the 8 weeks; there was no difference by condition. The website enabled adolescents to improve vegetable intake and daily physical activity, reduce sedentary behavior and had a high log on rate. Future research should identify effective methods for disseminating this website to wider audiences.

Parents' perceptions of preschool children's ability to regulate eating. Feeding style differences.

Parent feeding styles have been associated with childrens eating behaviors and weight status across multiple studies. However, little is known about the mechanism through which parent feeding styles influence child weight status. Childrens ability to self-regulate their eating may be the mechanism that links these two constructs. This study examined the relationship between parent feeding styles, child self-regulatory ability, and weight status to determine whether self-regulatory ability mediated the relationship between parent feeding styles and child weight status in a group of 296 parents and their preschool aged children. Indulgent feeding style was related to children having lessened satiety responsiveness and higher enjoyment of food (two components of self-regulation around eating) compared to other parent feeding styles. Children of parents with an indulgent feeding style were also higher in weight status compared to other feeding styles. Mediation analyses revealed that satiety responsiveness and enjoyment of food mediated the relationship between parent feeding style and child BMI z-score such that children of parents with indulgent feeding styles had lessened ability to self-regulate around eating and higher BMI z-scores. Findings from this study suggest that childrens ability to self-regulate eating might be an important mechanism by which parent feeding style and child weight are related to each other.

Differential Improvements in Student Fruit and Vegetable Selection and Consumption in Response to the New National School Lunch Program Regulations: A Pilot Study

OBJECTIVE To investigate changes in student food selection and consumption in response to the new National School Lunch Program meal patterns during fall 2011. DESIGN Eight elementary and four intermediate schools in one Houston area school district were matched on free/reduced-price meal eligibility and randomized into control or intervention conditions. INTERVENTION Both intervention and control school cafeterias served the same menu. The intervention school cafeterias posted the new meal pattern daily; students could select one fruit and two vegetable servings per reimbursable meal. Control school students could only select the previous meal pattern: a total of two fruit and vegetable servings per meal. MAIN OUTCOME MEASURES Students were observed during lunch: student sex and foods selected/consumed were recorded. Diet analysis software was used to calculate energy/food groups selected/consumed. STATISTICAL ANALYSES PERFORMED Cochran-Mantel-Haenszel χ² tests examined differences in the percent of students selecting each meal component by condition, controlling for sex, grade, and school free/reduced-price meal eligibility. Analysis of covariance assessed differences in amount of energy/food groups selected and consumed, and differences in percent of food groups consumed. RESULTS Observations were conducted for 1,149 elementary and 427 intermediate students. Compared with students in the control schools, significantly more intervention elementary and intermediate school students selected total (P<0.001, P<0.05) and starchy vegetables (P<0.001, P<0.01); more intervention intermediate school students selected fruit (P<0.001), legumes (P<0.05), and protein foods (P<0.01). There were significantly greater amounts of these foods selected and consumed, but no differences in the proportion of the foods consumed by condition. Fewer calories were consumed by elementary and intermediate school intervention students. CONCLUSIONS More intervention students selected fruit and vegetables at lunch and consumed them compared with control condition students. Future studies with larger and more diverse student populations are warranted.

Seasonal variability in weight change during elementary school

To examine seasonal variation in weight gain across elementary school (kindergarten‐5th grade) among children who are healthy weight, overweight, or obese and from different racial and ethnic groups.

Physical Activity and Screen-Media–Related Parenting Practices Have Different Associations with Children's Objectively Measured Physical Activity

BACKGROUND Childrens physical activity (PA) is inversely associated with childrens weight status. Parents may be an important influence on childrens PA by restricting sedentary time or supporting PA. The aim of this study was to investigate the association of PA and screen-media-related [television (TV) and videogame] parenting practices with childrens PA. METHODS Secondary analyses of baseline data were performed from an intervention with 9- to 12-year-olds who received active or inactive videogames (n=83) to promote PA. Childrens PA was assessed with 1 week of accelerometry at baseline. Parents reported their PA, TV, and videogame parenting practices and childs bedroom screen-media availability. Associations were investigated using Spearmans partial correlations and linear regressions. RESULTS Although several TV and videogame parenting practices were significantly intercorrelated, only a few significant correlations existed between screen-media and PA parenting practices. In linear regression models, restrictive TV parenting practices were associated with greater child sedentary time (p=0.03) and less moderate-to-vigorous PA (MVPA; p=0.01). PA logistic support parenting practices were associated with greater child MVPA (p=0.03). Increased availability of screen-media equipment in the childs bedroom was associated with more sedentary time (p=0.02) and less light PA (p=0.01) and MVPA (p=0.05) in all three models. CONCLUSION In this cross-sectional sample, restrictive screen-media and supportive PA parenting practices had opposite associations with childrens PA. Longitudinal and experimental child PA studies should assess PA and screen-media parenting separately to understand how parents influence their childs PA behaviors and whether the childs baseline PA or screen media behaviors affect the parents use of parenting practices. Recommendations to remove screens from childrens bedrooms may also affect their PA.

Maternal Feeding Styles and Food Parenting Practices as Predictors of Longitudinal Changes in Weight Status in Hispanic Preschoolers from Low-Income Families

Objective. The aim was to investigate the influence of feeding styles and food parenting practices on low-income childrens weight status over time. Method. Participants were 129 Latina parents and their Head Start children participating in a longitudinal study. Children were assessed at baseline (4 to 5 years old) and again eighteen months later. At each time point, parents completed questionnaires and height and weight measures were taken on the child. Results. The indulgent feeding style (parent-report at baseline) was associated with increased child BMI z-score eighteen months later compared to other feeding styles. Authoritative, authoritarian, and uninvolved feeding styles were not significantly associated with increased child BMI z-score. Child BMI z-score at Time 1 (strongest) and maternal acculturation were positive predictors of child BMI z-score at Time 2. Maternal use of restriction positively predicted and maternal monitoring negatively predicted Time 2 BMI z-score, but only when accounting for feeding styles. Conclusion. This is the first study to investigate the impact of feeding styles on child weight status over time. Results suggest that indulgent feeding predicts later increases in childrens weight status. The interplay between feeding styles and food parenting practices in influencing child weight status needs to be further explored.

Supplemental Nutrition Assistance Program participation did not help low income Hispanic women in Texas meet the dietary guidelines.

OBJECTIVE Low-income Hispanic women are at greater risk for dietary deficiencies and obesity. We assessed the association between Supplemental Nutrition Assistance Program participation and dietary intake among 661 Hispanic women aged 26-44 years living in Texas. METHODS Cross-sectional data was collected using standard methods. Analysis of variance and logistic regression examined the influence of Supplemental Nutrition Assistance Program on diet after adjusting for household characteristics, body mass index, and food security status. RESULTS Most women did not meet recommended dietary guidelines. Supplemental Nutrition Assistance Program participants consumed higher amounts of total sugars, sweets-desserts, and sugar-sweetened beverages than Supplemental Nutrition Assistance Program nonparticipants. High sodium intakes and low dairy consumption were observed in both groups. Only 27% of low-income eligible women received Supplemental Nutrition Assistance Program benefits. DISCUSSION Low-income Hispanic women participating in Supplemental Nutrition Assistance Program reported less healthful dietary patterns than nonparticipants. This may contribute to the increased obesity prevalence and related comorbidities observed in this population. CONCLUSION Supplemental Nutrition Assistance Program should play an important role in enhancing the overall dietary quality of low-income households. Policy initiatives such as limiting the purchase of sugar-sweetened beverages and education to enable women to reduce consumption of high sodium processed foods deserve consideration as means to improve the dietary quality of Supplemental Nutrition Assistance Program participants. Effective measures are needed to increase Supplemental Nutrition Assistance Program participation rates among Hispanics.

Obesity status transitions across the elementary years: use of Markov chain modelling

The objective of this study was to assess overweight and obesity status transition probabilities using first‐order Markov transition models applied to elementary school children.